MEDICARE: AIMEE W HURD NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	18599	TN
2	363LG0600X	Gerontology Nurse Practitioner	18599	TN

General Provider Information

NPI Number	:	1225457310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE W HURD NP

Provider Business Mailing Address
First Line	:	105 W STONE DR
Second Line	:	SUITE 6A
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3365
Country	:	US
Telephone Number	:	423-408-7220
Fax Number	:	423-408-7405

Provider Business Practice Location Address
First Line	:	316 MARKETPLACE DR
Second Line	:	SUITE 20
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-8934
Country	:	US
Telephone Number	:	423-433-6370
Fax Number	:	423-610-0045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2014
Last Update Date	:	07/21/2014

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